Medical insurance reimbursement scope:
1. The scope of medication, diagnosis and treatment items and medical service facilities of the insured shall be implemented with reference to the basic medical insurance system for urban workers in Zhuji City.
2. Only participants were hospitalized or suffered from special diseases during the settlement year: [( 1) outpatient radiotherapy and chemotherapy for malignant tumor 2) outpatient renal dialysis for uremia 3) outpatient anti-rejection treatment after organ transplantation 4) chronic aplastic anemia 5) systemic lupus erythematosus 6) decompensated cirrhosis 7) outpatient medical expenses for schizophrenia. Please refer to the scope of reimbursement.
3, in the town (street) community health service center, the approved designated community health service station for medical treatment of general outpatient medical expenses. Non-reimbursement scope
1, registration fee, out-of-hospital consultation fee, home visit fee, transportation fee, escort fee, air conditioning fee, family bed, special medical service fee, self-purchased drugs, etc.
2, beauty, plastic surgery, dental implants, weight loss, height, physical examination, preventive health care diagnosis and treatment projects, medical identification, medical consultation, etc.
3, the application of positron emission tomography (PET), electron beam CT, ophthalmic excimer laser therapeutic instrument, human information diagnostic instrument and other inspection and treatment projects.
4. Organ or tissue sources of all kinds of organ or tissue transplantation (except skin transplantation of burn patients), kidney, heart valve, cornea, skin, blood vessels, bone and bone marrow transplantation, myopia orthopedics, qigong, music therapy and healthy nutrition therapy.
5. Injuries caused by intentional acts such as fighting, alcoholism, self-injury, suicide, drug abuse and crime, traffic accidents (except self-injury by non-motor vehicles and bicycles), medical accidents, group poisoning incidents and medical expenses caused by third parties.
6. All expenses required for family planning such as pregnancy, abortion, childbirth, infertility and sexual dysfunction. All medical expenses incurred during the exit period, the inspection of high-tech and precise medical equipment approved by the Municipal Medical Management Office and the medical expenses incurred in non-designated medical institutions.
Legal basis: Article 23 of the Social Insurance Law of People's Republic of China (PRC), employees shall participate in the basic medical insurance for employees, and both employers and employees shall pay the basic medical insurance premium according to the provisions of the state.
Individual industrial and commercial households without employees, part-time employees who have not participated in the basic medical insurance for employees and other flexible employees can participate in the basic medical insurance for employees, and individuals pay the basic medical insurance premium in accordance with state regulations.
Article 24 The state establishes and improves the new rural cooperative medical system.
Measures for the administration of the new rural cooperative medical system shall be formulated by the State Council.
Article 25 The state establishes and improves the basic medical insurance system for urban residents.
The basic medical insurance for urban residents combines individual contributions with government subsidies.
People who enjoy the minimum living guarantee, disabled people who have lost their ability to work, elderly people and minors over 60 years old in low-income families, etc. , subsidized by the government.
Twenty-sixth basic medical insurance for employees, new rural cooperative medical care and basic medical insurance for urban residents shall be implemented in accordance with state regulations.
Twenty-seventh individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, will no longer pay the basic medical insurance premium after retirement and enjoy the basic medical insurance benefits in accordance with state regulations; Those who have not reached the fixed number of years prescribed by the state may pay the fees to the fixed number of years prescribed by the state.